Postmortem skeletal survey practice in pediatric forensic autopsies: a national survey.
ABSTRACT Recommendations for the evaluation of an unexplained death in infancy include a postmortem skeletal survey (PMSS) to exclude skeletal trauma. Objectives of this study were to assess adherence to these recommendations in forensic autopsies in children equal to or less than 36 months of age, and what factors influence the use or nonuse of the PMSS. We surveyed pathologists who were members of the American Academy of Forensic Sciences. The survey included practice characteristics about where, when, and how PMSS were done. Nearly all respondents (99.6%) indicated they performed PMSS at least some of the time; however, almost a third did not use PMSS for all suspected Sudden Infant Death Syndrome (SIDS), abuse, unsafe sleep, or undetermined causes of death. Despite evidence that "babygrams" are inappropriate in a SIDS workup, 30% of pathologists use them preferentially. Despite SIDS being a diagnosis of exclusion that requires a PMSS, almost 10% of pathologists do not order a PMSS. Future research is necessary to reduce barriers to this important component of the pediatric forensic autopsy.
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ABSTRACT: The involvement of a pathologist with forensic and pediatric training in all stages of the assessment of sudden and unexpected infant death (SUDI) is crucial as pathologists are among a limited group of medical practitioners who have been trained in evaluating the interaction of injuries, disease processes, and post-mortem changes. However problems exist, with variations in the quality of pediatric autopsy practice and in diagnostic categories that are applied. While the development of standard definitions and protocols has improved this situation, use of the term SUDI as an umbrella term has also assisted in evaluating trends and reducing the impact of diagnostic shift. The following paper reviews the contributions that may be made by pathologists in cases of SUDI, from an initial evaluation of a death scene, through the autopsy process, discussions with families, research and participation in multidisciplinary death review committees.Current Pediatric Reviews 01/2010; 6(1):21-26.